Innovation and Institutional Change Sacramento, CA May 2, 2003

1. Innovation and Institutional ChangeSacramento, CA May 2, 2003 Edward O’Neil, MPA, PhD Center for the Health Professions, University of California, San Francisco

2. Agenda • What challenges us in health and service delivery? • What evidence for investing in leadership? • Core individual and corporate competencies for innovation and change

3. Total system costs are a huge burden Cost • Enormous range in definition of quality Variation • Over/under supply of care providers, hospitals, insurers. Capacity • Substitutable inputs Duplication • +15% uninsured Access Leadership Challenge

4. Leadership Challenge • Stressed care delivery system and institutions • Tighter resources • Lack of direction • Greater demands • Technology • Quality • Uncertainty • Inability to adapt and change rapidly • Half born revolution

5. Leadership Challenge The Challenge of leadership has always been to provide coherence, structure, and ultimately, meaning in times of great change and dislocation, … but how.

6. Leadership Lessons Learned • Competency project • Leadership programs at CHP • Leadership literature

7. Leadership Challenge: Activating Seven Core Competencies Leadership

8. 1. Build and adapt a compelling vision and strategy • Transformational in nature, nothing else worth doing • Drawn from past success and assets • Developed with clear and honest assessment of environment • Ceilings and floors • Given adequate time to develop, mature and be realized

9. Assessment: Vision • Do you know the two to three key elements of your organization's vision and the current strategy to achieve the vision? What are they? • What are the two ways this drives the work of your unit? • What thirty second message do you deliver that distinguishes your organization and your work from competitors? • How does the strategically aligned work of your unit connect with one key customer or internal constituent around this vision? • How will you use budget, personnel and attention to drive alignment to organizational strategy in the coming three months?

10. 2. Create and manage alliances, partnerships and acquisitions • Screen partners against strategy, competencies and assets • Recognize necessity of mutually beneficial strategies • Reject partners that see you as a way to postpone the inevitable • Partners force new accountabilities

11. Assessment: Partners • Do you know where you need help from outside or inside to deliver your part of the strategy? • Do you know who these potential partners are? • What is the potential partner’s interest in working with you? • Are there things that you do now that can be given up in a partnership? • What skills do you need create and carry out this partnerships?

12. Use population based science in day to day management • Population attitude on the part of everyone • Integration of disease, demand and outcomes management with customer service, marketing and diversity • Evidence based approaches tied to information system • Alignment of reward system with population goals

13. Assessment: Population • Do you understand the relevant dimensions of the populations you serve: size, disease state, consumer preferences, cultural diversity? • What other dimensions are relevant? • What benchmarks do you have for serving this population and what evidence do you collect to assess progress? • What measures are collected daily, weekly, monthly and annually? • What can you do to improve the engagement of a relevant population in service?

14. 4. Communicateconsistent messages about vision, mission, and alignment • Clear, simple messages consistently expressed • Internally to align purpose and work • Externally gain confederates • Remember the key to alignment is listening • Address anxiety and uncertainty with clarity, resolve and commitment to work together to common ends • Make sure actions follows words

15. Assessment: Communication • What are two opportunities you have to improve internal communication? • What are two audiences and avenues you have to improve external communication? • How are you perceived as a communicator? • How can you receive feedback on improving your communications?

16. 5. Invest in human resources processes • Remember the anxiety of people in a changing system • Build a context that changes direction and incentives • Build collaborative teams throughout • Develop of new skills and competencies • Identify clear system outcomes and tie personnel performance appraisal to these outcomes

17. Assessment: HR/OD • Are human resources seen as a strategic assets? • What is the plan to integrate and development human resources at the corporate level? • What is your plan for developing your key direct reports? • What is your development plan? • How do you use this resource to address the chaos of the environment?

18. Build innovation and creativity • Success marked by an ability to continuously improve quality of care and reduce costs • Creativity comes by education and focused work • Radical ideas arrive in a way they can be adapted not dismissed • Be creative but allow time for acceptance and development

19. Assessment: Creativity • Are you comfortable with creativity? • What is the natural history of creative ideas in your organization ? • What constrains your creativity? • How is creativity rewarded?

20. 7. Build the capacity to manage change • Assume a discontinuous world • Work within the framework of strategy, but be prepared to adjust • Conscious attention to change • Use adaptive work • Disrupt with new ideas, technologies • Prepare and equip to manage conflict • Continuously educate and improve • Understand how, when and where to make decisions

21. Assessment: Change • How do you feel about change? • Does your organization value or discount change? • What can you do as a leader/manager to encourage a different attitude? • How would you make your position unnecessary?

22. The Myth of Sisyphus We tend to think of Sisyphus as a tragic hero, condemned by the gods to shoulder his rock sweatily up the mountain, and again up the mountain. The truth is that Sisyphus is in love with the rock. He cherishes every roughness and every ounce of it. He talks to it, sings to it. It has become the mysterious Other. He even dreams of it as he sleepwalks upward. Life is unimaginable without it, looming always above him like a huge gray moon.

23. The Myth of Sisyphus He doesn’t realize that at any moment is permitted to step aside, let the rock hurtle to the bottom, and go home. Tragedy is the inertial force of the mind. Stephen Mitchell, Parables and Portraits

24. For more information, please contact: UCSF Center for the Health Professions 3333 California Street, Suite 410 San Francisco, CA 94118 415/476-8181 HTTP://FUTUREHEALTH.UCSF.EDU eoneil@itsa.ucsf.edu